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General NPI Number Information
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NPI Number | 1366272296
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Entity Type | Organization
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Legal Business Name | MDC MOBILE PHLEBOTOMY
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 15052 W CLUB DELUXE RD STE B
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City | HAMMOND
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State | LA
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Zip | 70403-1216
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Country | US
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Telephone | 504-812-4528
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1747
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City | NATALBANY
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State | LA
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Zip | 70451-1747
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Country | US
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Telephone | 504-812-4528
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | SAKIE MERRELL
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Credential |
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Telephone | 504-812-4528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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